1/5/2021 IB Form

Applicant Details

Personal Details

Application Sequence No
MHA141200250

Candidate's Name
DHEERAJ ASHOKRAO GHOTE

Father's Name Mother's Name

ASHOK SUREKHA

Marital Status Nationality

Unmarried A Citizen of India

Religion ID Proof

Hinduism Aadhar Card

Aadhar Number Home State

411503170048 Maharashtra

Post Applied Details

Exam City Choice 1

Post Applied Pune
Assistant Central Intelligence Officer- Grad
e II/Executive
Exam City Choice 2
Aurangabad(Maharashtra)

Exam City Choice 3 Category

Nanded EWS

Gender Date of Birth same as Matriculation/ Secondary

Certificate
Male
15/Aug/1996

Age as on 09.01.2021 Are you an Ex-Service man?

No
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24 Years 4 Months 25 Days

Are you a Departmental Candidate who have
rendered 3 years of regular & continuous service in
central government ?

No

Were you originally domiciled in the state of Jammu Are you a dependent of victim of communal riot of
and Kashmir between 01.01.1980 and 31.12.1989 as 2002 in Gujrat?
well as the children?
No
No

Are you a Sportsperson?

No

Contact Details

Mobile Number

8408822772 Email ID

pdheeraj31@gmail.com

Present Address

Address Line 1

santai nivas narayan nagar ausa road latur

Address Line 2

near zhulelal temple

Country

India

State City

Maharashtra Latur

Pin Code

413512

Permanent Address

Address Line 1

santai nivas narayan nagar ausa road latur

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Address Line 2

near zhulelal temple

Country

India

State City
Maharashtra Latur

Pin Code

413512

Matriculation (10th) Details

Name of the Board/Council

maharashta state board of secondary and higher secondary education

Year Of Passing
2012 Institute Name

shree deshikendra vidyalaya latur

Percentage of Marks
Subject Combination 82
marathi sanskrit english math science soci
al science
Certificate Number
S121730350

Course Type

R(Regular)

10+2 Details/Diploma Details

Select Option

Diploma

Name of the Board/Council

MSBTE

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Year Of Passing Institute Name

2015 VAPM ALMALA

Percentage of Marks
Subject Combination 72.73
MANAGEMENT TESTING POWER ELECTRONI
CS ILLUMINATIN TRACTION PROJECT SCESSI
Certificate Number
ONAL WORK
1015189

Course Type Whether this institute is recognised by the

state/central government ?
R(Regular)
Yes

Essential Qualification Details

Qualification Name

Graduation or Equivalent from recognized university

Specialization

ELECTRICAL Institute Name

JSPM WAGHOLI

Year Of Passing Percentage of Marks

2018 61.06

Certificate Number Course Type

B120732525 R(Regular)

Desirable Qualification

Do you have Knowledge of Computers ?

Yes

Payment Details

Amount Payment Status

600 Successful

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Payment Transaction No.

CPAANPHQG7

Candidate Photo and Signature Upload Details

Photo

Signature

Declaration

I hereby, solemnly declare that the information given above is true and correct to the best of my
knowledge and I fulfil the eligibility conditions laid down in the detailed advertisement, for
appearing in the recruitment test conducted by Ministry of Home Affairs for the post of Assistant
Central Intelligence Officer Grade-II/Executive. I further declare that in case any of the above
information is found to be false/incorrect or any information is found to be suppressed or any
ineligibility being detected before, during or after the recruitment process, my candidature for this
post is liable to be forfeited. I further declare that I am not involved in any criminal case and/or no
such case is pending against me in the court of law.

Version 13.09.00

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